DiscussionOur obtained results show

Discussion
Our obtained results showed that simultaneous administration of three modes of airway care including regulating the cuff pressure in range of 25 cm H2O, elevation of bed head up to 45° and its maintenance at this position, and oral and subgluteal suctioning before each patient's position change resulted in a reduction in VAP. Previous studies have not investigated the simultaneous and cumulative effect of these variables on VAP, but some studies have been conducted on the effect of each of these methods on VAP. Drakulovic et al. also showed that elevation of patients’ bed head up to 45° significantly decreased the incidence of VAP, compared to supine position, which is consistent with the present study.[17] Chow et al. showed that continuous oral suctioning led to lowered incidence of VAP.[20]